Facility Evaluation Report

New Haven, Walnut Creek05/04/2023Licence 079200781

Capacity6
Census3
Date signed05/05/2023 11:36:49 AM
The inspector’s account

On 05/04/2023 at 2:15 PM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced to conduct a Required Annual Inspection. Upon entry, LPA disclosed the purpose of the visit with Lead Staff Marilou Ladaban. At approximately 4:30 PM, Administrator (ADM) Elizabeth Cortes-Palad arrived.

The LPA and Ms. Ladaban toured the facility inside and outside. The inspection was incomplete and will require an additional visit to be complete.

During the inspection, 1 A-Type and 1 B-Type citation were issued (refer to LIC809-D for details). 3 Technical Violations issued for violations of the regulations that do not pose a risk to the health and safety of persons in care.

Updated copies of the following documents were requested for facility file and are to be submitted to CCL on or before 05/11/2023:

· LIC308 - Designation of Facility Responsibility

· Evidence of Current Liability Insurance

Exit interview conducted and a copy of this report provided via email.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction